Provider Demographics
NPI:1710988118
Name:SWAIN, ASHA L (MD)
Entity Type:Individual
Prefix:
First Name:ASHA
Middle Name:L
Last Name:SWAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 11TH ST
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-4605
Mailing Address - Country:US
Mailing Address - Phone:814-943-8909
Mailing Address - Fax:814-943-2199
Practice Address - Street 1:1200 11TH ST
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4605
Practice Address - Country:US
Practice Address - Phone:814-943-8909
Practice Address - Fax:814-943-2199
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD85221207Q00000X
PAMD039078L207Q00000X
VA0101262966207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC34026Medicare UPIN
PA432075Medicare PIN